Abstract
Bone histomorphometry remains the gold standard in the assessment and distinction of the different types of renal osteodystrophy. It reflects th sskeletal part of the mineral and bone disorder of chronic kidney disease (CKD-MBD), which also comprises disturbances of mineral metabolism and soft-tissue calcifications. Unfortunately, bone histomorphometry relies on bone biopsies, an invasive procedure. None of the other presently available diagnostic approaches such as non-invasive imaging techniques or circulating biomarkers allows a similarly precise assessment of bone turnover and mineralization [...]
Highlights
Carbonara et al set out to examine this issue using the Brazilian Registry of Bone Biopsy (REBRABO)[4]
The study included 260 patients with CKD stages 3-5D and a follow-up of 12-30 months. They assessed available clinical, laboratory, and bone histomorphometry data and classified the bone biopsy findings as osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, or osteomalacia based on bone turnover, mineralization, and volume (TMV) status
The indications for a bone biopsy were heterogeneous: research protocol in 41%, suspicion of aluminum overload in 31%, persistent bone pain in 13%, unexplained hypercalcemia/hyper phosphatemia in 5.4%, nontraumatic bone fracture in 4.2%, planned bisphosphonate therapy in 3.1%, and projected parathyroidectomy in 2.3% of the patients
Summary
Carbonara et al set out to examine this issue using the Brazilian Registry of Bone Biopsy (REBRABO)[4]. They assessed available clinical, laboratory, and bone histomorphometry data and classified the bone biopsy findings as osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, or osteomalacia based on bone turnover, mineralization, and volume (TMV) status. Bone biopsy in chronic kidney disease in patients with low compared to those with normal bone trabecular volume, and for a higher prevalence of myalgia in the presence of abnormal bone mineralization.
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